Residency Training and International Medical Graduates: Coming to America No More

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By 2015, the number of graduates from US medical schools is anticipated to surpass the number of positions in residency programs.1 Because the vast majority of US medical school graduates will choose to remain in the United States, and most residency programs will continue to give preference to US graduates, the number of international medical graduates (IMGs) who train in the United States is expected to decrease (Figure). Although many may see this as a positive development (US programs have been accused of exacerbating the “brain drain” from developing countries), this decrease may have additional unanticipated consequences for the diversity and activities of physicians practicing in the United States—a shift that could begin to affect patient care.

Figure. Trends in Applicants Participating in the National Resident Matching Program (NRMP) and Number of PGY-1 Positions, 1991-2011

The number of US international medical graduates (IMGs) increased from 601 in 1991 to 3769 in 2011 (>6-fold) compared with non-US IMGs, which noted an increase from 2259 in 1991 to 6659 in 2011 (<3-fold). Postgraduate year 1 (PGY-1) positions increased from 20 192 in 1991 to 23 421 in 2011. The solid line indicates number of PGY-1 positions. (Data source: http://www.nrmp.org/data/.)

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